What is this?
This procedure involves telescopic inspection of the bladder and urethra combined with insertion, removal or changing of a soft plastic tube placed between the kidney and the bladder. The procedure is usually performed under X-ray control
What alternatives are there?
Observation, placement of a tube directly into the kidney through the back (nephrostomy), open surgical treatment.
What to expect before procedure
You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. You will usually be given injectable antibiotics before the procedure, after checking for any allergies. A telescope is inserted through the water pipe (urethra) to inspect both the urethra itself and the whole lining of the bladder. A stent is then inserted into the ureter, using the telescope, under X-ray guidance.
After the procedure
You will normally be allowed home once you have passed urine satisfactorily. If a catheter is left in place, this will normally be removed within 24 hours and you will be discharged once you have passed urine satisfactorily. The average hospital stay is 2 days.
Potential side effects
When you leave hospital, you will be given a draft discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. When you get home, you should drink twice as much fluid as you would normally for the next 24-48 hours to flush your system through. You may find that, when you first pass urine, it stings or burns slightly and it may be lightly bloodstained. In approximately 60% of patients some discomfort, similar to cystitis, persists until the stent is removed. Simple painkillers will usually help but there is nothing to be gained from treatment with antibiotics unless there is a proven urinary infection. Occasionally, this pain can be severe enough to merit early removal of the stent.
What to look out for
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately.
A follow-up appointment will be arranged before your discharge from hospital and may involve an outpatient clinic appointment, arrangements for you to have your stent removed at a later date or further treatment (e.g. lithotripsy). If you have any concerns about the timing of further treatment, please discuss this with your named nurse or Consultant. Stents do not normally need to remain in place for more than 6 weeks. Please let us know If you have not heard from us about removing your stent within 6 weeks or so of your discharge. A specific information sheet on what to expect with an ureteric stent is available from the ward or from the Specialist Nurse.
There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly Audit & Clinical Governance meeting.